![]() ![]() During a year of collaborative care, the initiation of opioids failed to improve function, but caused more adverse effects and marginally worse pain intensity. The absence of long-term efficacy data has finally been addressed in a landmark randomised controlled trial of long-term opioids compared to non-opioid medicines for chronic musculoskeletal pain. 17 Dispensing in Australia increased 15-fold between 19, predominantly reflecting long-term opioid provision for chronic pain. Prescribing opioids for over a week for acute pain doubles the risk of long-term use at one year (6% to 13%) and this risk doubles again (to 29.9%) if the initial prescription lasts a month. There is evidence to support long-term opioids as substitution therapy to minimise harm from dependency in opioid use disorders. Guidelines for using opioids to treat pain have changed markedly, with prescription now being recommended only for acute pain, active cancer pain or palliative care. 16The patient should be encouraged to do the best they can without significantly flaring their pain. Use the Five Times Sit to Stand Test (taking over 15 seconds correlates with an increased risk of falls). 14 Ask what the patient is concerned about or fears the most regarding their pain. Identify psychosocial risks early using a tool such as the ten-item Örebro Musculoskeletal Pain Screening Questionnaire. 12 The three‑item PEG scale allows a broader and readily repeatable assessment and only requires a few extra seconds. Just asking patients how bad their pain is out of 10 is simplistic in chronic pain and tends to elicit default opioid prescriptions. Regular use of validated brief outcome tools.Practice nurses can play a role in implementing time‑efficient assessments of chronic pain. Additional components incorporate physical activity, sleep patterns, nutrition, and past or current use of addictive substances including prescription drugs. The psychosocial dimension includes assessment of mood, cognitions, trauma, suicide risk and the social context of the presenting problems (e.g. Practice policies, holistic assessment then drug and non-drug approaches need to be explored.Įven in acute pain, standard care is enhanced by a broad, ‘whole person’ assessment. ![]() Multimodal, multidisciplinary chronic pain care can be translated into time-poor primary care settings. 7 For this reason, it is important GPs do not feel that treating chronic pain simply requires a choice between prescribing opioids or referring to specialist care. 11 However, GPs have the advantage of capacity, accessibility (geographical and financial) and the potential to provide longitudinal, holistic and opportunistic care. 10 While less expensive, GP care does not become cost effective until it addresses physical disability alongside pain-related thoughts, emotions and behaviours. 6-9 However, a large US outpatient study found that only 0.12% of chronic pain consultations involved pain specialists. Trials indicate that the best care for chronic pain involves self-management by the patient and a multidisciplinary approach through a pain centre rather than GP ‘treatment as usual’. 4, 5 Chronic pain challenges classic models of diagnosis and treatment. 3 Almost half of GP consultations involve some discussion of pain, usually relegated behind comorbidities such as obesity and diabetes or psychiatric and substance-use disorders. 2Ĭhronic pain is defined as pain lasting beyond the time of tissue healing or for over three months. 1 This presents a major challenge because of the number of patients involved – over 15 million packs of over-the-counter opioid analgesics were purchased in Australia in 2013, accounting for 36.6% of total opioid pack sales. Codeine rescheduling in February 2018 prevented consumers accessing over-the-counter opioids without a prescription. ![]()
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